三通道电刺激仪的研制及对臂丛神经损伤的临床疗效

目的:研制可用于臂丛神经损伤治疗的三通道电刺激仪,并且将之应用于临床臂丛神经损伤患者,观察该仪器治疗臂丛神经损伤的临床效果。方法:由主控模块、显示模块、键盘模块、三个通道的电刺激发生器模块以及电源模块组成系统,可以连续交替释放脉冲刺激,针对不同神经和肌肉,选择不同的刺激位点。将60例臂丛神经损伤术后的患者随机分成试验组(30例)和对照组(30例),试验组术后第三周使用三通道电刺激仪治疗,对照组不做处理,患者术后随访6-12月后,观察患者上肢肩部、肘部功能恢复情况。结果:试验组治疗后上臂丛、全臂丛、下臂丛的肩部、肘部功能均好于治疗前,差异明显,均有统计学意义(P0.05);试验组上臂丛、全臂丛、下臂丛的肩部、肘部治疗效果均显著优于对照组,差异有统计学意义(P0.05)。结论:三通道电刺激仪可以有效地促进臂丛神经损伤后上肢功能的康复,可以对三组神经和肌肉交替进行电刺激,使用方便,并且便于携带,患者较为满意。     

Growth status of disadvantaged urban Guatemalan children of a resettled community

This paper reports the physical growth and body composition from the first year of longitudinal study of 519 Guatemalan children, and their families, from a disadvantaged urban community consisting largely of refugees of the 1976 earthquake. Four cohorts are described, composed of children of 1,3,5, and 7 years at examination. The children are smaller, weigh less, and have reduced fat stores compared either to NCHS reference data or to upper SES Guatemalan children. Stature (or length) and head circumference deviate more from reference data than do triceps or upper arm muscle circumference. Greater deviations are found in the linear dimensions of males than of females. These children are the smallest yet described from Guatemala City, though they are slightly larger than available rural samples. This suggests a continuum of environmental effects acting upon the growth of children of differing socioeconomic levels.     

Relationships between cognitive and motor abilities in female children aged 10-14 years

The aim of the study was to determine cognitive and motor status factors in female children aged 10-14 years and to identify developmental and/or integration functions according to age. The study included a sample of 162 female schoolchildren aged 10-14 years divided into two groups: 84 girls aged 10-12 (X 11.26, SD 0.68) years and 78 girls aged 13-14 (X 13.52, SD 0.63) years. Study results showed a statistically significant between-group difference in the overall system of variables (MANOVA), with the level of significance determined for each individual variable (ANOVA). The older group of subjects showed significantly superior results in comparison with the younger group in the motor tests assessing flexibility, agility, psychomotor speed, explosive strength of throwing type and repetitive strength of the trunk, as well as in the test assessing cognitive functioning. Qualitative differences between the two age groups (prepubertal and pubertal) were determined by use of the matrix of variable inter-correlations factorized by the procedure of principal components that were then transformed to promax solution. The results thus obtained indicated cognitive functioning to take significant part in the motor efficacy of girls aged 10-14 years. In the younger age group (10-12 years), cognitive functioning was related to the motor system that integrates muscle tone regulation and agility/coordination. In the older age group (13-14 years), cognitive functioning was involved in the formation of the first and third factor isolated, i.e. in the factor regulating coordination and intensity of energy mobilization of lower extremities (general motor efficiency) and, to a lesser extent, in third factor regulation the intensity of energy mobilization of upper extremities and trunk strength.     

Imaging tumor-induced sentinel lymph node lymphangiogenesis with LyP-1 peptide

Lymphangiogenesis in tumor-draining lymph nodes (LNs) starts before the onset of metastasis and is associated with metastasis to distant LNs and organs. In this study, we aimed to visualize tumor-induced lymphangiogenesis with a tumor lymphatics-specific peptide LyP-1. The LyP-1 peptide was labeled with a near-infrared fluorophore (Cy5.5) for optical imaging. At days 3, 7, 14 and 21 after subcutaneous 4T1 tumor inoculation, Cy5.5-LyP-1 was administered through the middle phalanges of the upper extremities of the tumor-bearing mice. At 45?min and 24?h postinjection, brachial LN fluorescence imaging was performed. Ex vivo fluorescence images were acquired for quantitative analysis of the fluorescence intensity. Tumor-induced lymphangiogenesis was confirmed by LYVE-1 immunostaining and increased size of tumor side brachial LNs. Cy5.5-LyP-1 staining in LNs co-localized with LYVE-1, suggesting lymphatics-specific binding of LyP-1 peptide. The brachial LNs were clearly visualized by optical imaging at both time points. The tumor side LNs showed significantly higher fluorescence intensities than the contralateral brachial LNs at days 7, 14, and 21, but not day 3 after tumor inoculation. At day 21 after tumor inoculation, the average signal of tumor-draining LNs was 78.0?±?2.44, 24.3?±?5.43, 25.6?±?0.25 (×10³?photon/cm²/s) using Cy5.5-LyP-1, Cy5.5-LyP-1 with blocking, and Cy5.5 only, respectively. Tumor-draining brachial LNs showed extensive growth of lymphatic sinuses throughout the cortex and medulla. Use of LyP-1 based imaging probes with optical imaging offers a useful tool for the study of tumor-induced lymphangiogenesis. LyP-1 may serve as a marker of lymphangiogenesis useful in detecting “high risk” LNs before tumor metastasis and after micro-metastasis, as well as for screening potential anti-lymphatic therapies.     

Theoretical contribution of the upper extremities to reducing trunk extension following a laboratory-induced slip

Slips are frequently the cause of fall-related injuries. Identifying modifiable biomechanical requirements for successful recovery is a key prerequisite to developing task-specific fall preventive training programs. The purpose of this study was to quantify the biomechanical role of the upper extremities during the initial phase of a slip resulting in trunk motion primarily in the sagittal plane. Two groups of adults were examined: adults over age 65 who fell and adults aged 18–40 who avoided falling after slipping. We hypothesized that rapid shoulder flexion could significantly reduce trunk extension velocity, that adults who slipped would implement this as a fall avoidance strategy, and that younger adults who avoided falling would use this strategy more effectively than older adults who fell. The kinematics of the 12 younger adults and eight older adults were analyzed using a three-segment conservation of momentum model developed to represent the trunk, head, and upper extremities. The model was used to estimate the possible contribution of the upper extremities to reducing trunk extension velocity. The model showed that upper extremity motion can significantly reduce trunk extension velocity. Although the upper extremities significantly reduced the trunk extension velocity of both young and older adults (p<0.027), the reduction found for the young adults, 13.6±11.4%, was significantly larger than that of the older adults (5.8±3.4%, p=0.045). Given the potential for trunk extension velocity to be reduced by rapid shoulder flexion, fall prevention interventions focused on slip-related falls may benefit from including upper extremity motion as an outcome whether through conventional or innovative strategies.     

Changes in body proportions of Japanese medical students between 1961 and 1986

Since 1945, the Japanese physique has changed a great deal. Physical examinations of medical students at Kyushu University have been carried out on an annual basis since 1939. We investigated changes in body proportions using data on 813 medical students examined from 1961 to 1986. During these 26 years, standing height has increased by 4.69 cm, arm length by 2.58 cm, and sitting height by 0.79 cm. Thus, the Japanese have grown taller and their extremities are longer, yet the trunk has not changed significantly. This study also shows a 10-year delay in increase in length of the upper extremities.     

Biomechanical pressures and upper extremity asymmetry: a study on young laborers

The purpose of this study is to reveal the impacts of biomechanical pressures of heavy working conditions on the upper extremities of young laborers. The study covers the examination of the upper extremities of 104 young laborers in the industrial workshops of Ankara, Turkey regarding bilateral asymmetry. The average age of the laborers was 18.48 +/- 0.61 years. The control group consisted of 102 non-laborers with an average age of 18.39 +/- 0.58 years. The laborers were measured with regard to width of elbows, wrists, and hands, and the length of hands. No significant difference between the groups was observed with the exception of average wrist width. However, while the labor group showed directional asymmetry in all measurements, the non-laborers exhibited directional asymmetry only in hand width and length. Consequently, the study revealed that biomechanical pressures tend to increase directional asymmetry in the upper extremities.     

Gender differentiations of cognitive-motor functioning in prepubertal and pubertal children

The aim of this study was to determine cognitive and motor status factors in female and male children aged 10-14, as well as developmental and/or integration functions according to gender. The study included 162 girls and 134 boys aged 10-14, divided into four groups: 84 girls aged 10-12 (mean age 11.26, SD 0.68), 84 boys aged 10-12 (mean age 11.41, SD 0.50), 78 girls aged 13-14 (mean age 13.52, SD 0.63) and 50 boys aged 13-14 (mean age 13.21, SD 0.53). The significance of quantitative differences between boys and girls in the overall system of variables was defined based on the results of canonic discriminant analysis of variance, and within each variable based on the results on univariate analysis of variance (ANOVA). In the younger age group (10-12 years), girls were superior to boys in a test assessing flexibility (Seated straddle stretch), whereas, compared to girls, boys had greater strength of the trunk (Crossed-arm sit-ups), greater explosive strength ofjump and sprint type (Standing broad jump and 20 m dash), and coordination (Obstacle course backwards and Steps laterally). In the older age group (13-14 years) differences in flexibility were even more prominent in favor of girls, whereas the differences in explosive strength increased in favor of boys, especially of the throwing type with better agility (Steps laterally), balance (Board balance) and greater static strength of arms and shoulders (Bent-arm hang). In order to determine qualitative differences between pubertal and prepubertal girls and boys, the matrix of variable inter-correlations was factorized by the procedure of principal components procedure, that were then transformed to promax solution. The results showed that cognitive functioning had a significant role in the motor efficacy of girls and boys aged 10 to 14. In the age group of 10-12 years, in females, cognitive functioning is related to the motor system which integrates the regulation of muscle tone with agility/coordination, whereas in males there is a relation between cognitive abilities and the regulator of speed of upper extremities movement frequency. In the age group of 13-14 years, in females, cognitive functioning is involved in forming the factors for regulation of coordination and the intensity of energy mobilization in lower extremities, and to some degree, in the factor for regulation of intensity of energy mobilization in upper extremities and strength of the trunk, whereas in males the integration of synergetic regulation of movement in terms of balance and agility in terms of speed of direction change is carried out with significant involvement of cognitive abilities.     

Dynamic age-related changes in the human physique at stages in postnatal development

In 926 children (7 age groups) combined group differences of the signs have been studied by means of a unified standardized method, using the hand length as a linear measure; the conformity index to definitive size has been applied. For newborns proportional discrepancy to the definitive sizes is specific. They have a relatively long, thick and round body, short extremities, large dimensions of the head and abundant adipose subcutaneous deposits. According to the constitutional peculiarities the newborns resemble the children of the digestive type in mature persons--pycnotic or endomorphic. Beginning from birth, including children of early and first childhood (4-7 years of age), age changes of complexion go in two directions: a) dolichomorphy of complexion is realized; for it decreasing diameters of the chest and dimensions of the neck, chest, abdomen, pelvis (in boys), shoulder, arm, hand, foot and decrease in the subcutaneous adipose tissue are specific; b) longitudinal proportions of body and extremity segments change under influence of biomechanical adaptations to physical loads in connection with adaptation to the vertical position.     

Dog bites in New York City

The purpose of this review is to characterize the public health problem of dog bites in New York City. Dog bites represent a major source of morbidity, mortality, disability, and health care cost in the United States. The most severe injuries are frequently referred to the plastic surgeon. The authors have recently treated several severe cases of unprovoked dog attacks in children. To characterize the dog bite problem in New York City, data were obtained for 1998 from the New York City Department of Health. During that year, 6568 bites were reported by the mandated physician reporters in the five boroughs of New York City. The upper extremities, lower extremities, and face were predominantly affected. The peak incidence occurred during the summer months and in children ages 7 to 9 years old. Preventive measures are discussed.     

Echography of the kidney and its calyceal-pelvic complex in comparison with the anatomic and roentgenographic data

Anatomical and echographic data have been compared in 35 mature human kidneys. Ultrasound anatomy of the kidney has been verified. It has been stated that the central part of the renal echogram is occupied by the zone of intensive echosignals, that corresponds not to the calyceal complex, as it had been considered previously, but to the renal sinus. The renal sinus filled with fatty tissue and small arterial and venous vessels, their diameter is below the resolving power of the ultrasound device, is visualized as fused intensive echosignals of an elongated form, when the renal scanning is longitudinal, and as oval or round -- when the scanning is transversal. The calyceal-pelvic complex, filled with liquor, is presented as an anechogenic branching structure, situating within the zone of an increased echogeneity. The echographic picture of the calyceal-pelvic complex is always fragmentary: as small anechogenic areas in the hyperechogenic zone mentioned (the small pelvic calyces), or an excentrically situated anechogenic zone near the hilus renalis (the renal pelvis). In order to make the echographic investigations more accurate, it is necessary to follow certain methodical requirements, anatomical comparisons including.     

Sources of infection in childhood tuberculosis in a region of east Croatia

Possible sources of tuberculosis (TBC) infection in children have been assessed in a retrospective epidemiological study covering a north-east region of Croatia in which the incidence of childhood tuberculosis has been increasing since the war in 1991-1995. During the past decade (1993-2003), 271 children up to 18 years of age have been referred for hospital care because of known contacts with tuberculosis (142 children, group A) or because of indicative clinical signs and symptoms (129 children, group B). Possible sources of infection were identified on the basis of medical documentation and field investigations. Frequencies of source identification for different age groups were compared. In group A, the exposure took place most often within the family (parents, grandparents, siblings, 129 of 142 children, 90.87%). Relatives, neighbors, friends and schoolmates accounted for 9.2%. In group B, possible sources of infection were identified for 44 of 129 children (34.1%) and were within the family for 16 of those 44 (36.4%). Evidenced contact with tuberculosis was more usual among younger children (0-9 years of age, 65.5%) in group A than among the older ones (10-18 years of age, 34.5%). In group B, contacts with tuberculosis were equally distributed (50.0%) among younger and older children. High proportion of unrecognized contacts in children having clinical signs and symptoms indicative of tuberculosis (group B, 85 of 129, 65.9%) opens the possibility that extra-familial exposure to tuberculosis occurs more often than expected regardless of the age of children.     

Age and flow-mediated dilation: a comparison of dilatory responsiveness in the brachial and popliteal arteries

Previous investigations of age-associated changes in flow-mediated vasodilation (FMD) in women have been limited to the upper extremity and have not accounted for possible age differences in the stimulus for dilation. The purpose of the present study was to compare age differences in brachial and popliteal FMD and its stimulus (changes in shear rate following occlusion). Ultrasound-derived diameters and Doppler flow velocities of the brachial and popliteal arteries were measured in 14 young (20- to 30-yr-old) and 14 older (60- to 79-yr-old) healthy women at rest and during and after 5 min of distal cuff occlusion. Resting diameters were similar (both P > 0.39) in both age groups. Peak shear rate did not differ with age in either artery: approximately 1,300-1,400 and approximately 400-500 s(-1) in brachial and popliteal arteries, respectively. FMD (percent change above diameter measured during occlusion) was approximately 50-60% lower (P < 0.05) in the brachial (15.8 + 0.8% vs. 8.1 + 1.5%) and popliteal (4.6 +/- 0.7% vs. 1.8 +/- 0.4%) arteries of the older women. The normalized response of the brachial and popliteal arteries (%FMD per unit change in shear rate) was also reduced with age (55% and 53%, respectively) but did not exhibit limb specificity. Additionally, endothelium-independent dilation, as assessed by administration of nitroglycerin, was similarly blunted (by 45-65%) in brachial and popliteal arteries of older women. These results suggest that 1) brachial and popliteal artery FMD (after 5 min of distal occlusion) are similarly reduced with age, 2) when normalized to the change in shear stimulus, both arteries are equally responsive to 5 min of distal cuff occlusion in women, and 3) the age-associated decline in FMD may be attributable in part to diminished smooth muscle responsiveness.     

Developmental changes in upper airway dynamics.

Normal children have a less collapsible upper airway in response to subatmospheric pressure administration (P(NEG)) during sleep than normal adults do, and this upper airway response appears to be modulated by the central ventilatory drive. Children have a greater ventilatory drive than adults. We, therefore, hypothesized that children have increased neuromotor activation of their pharyngeal airway during sleep compared with adults. As infants have few obstructive apneas during sleep, we hypothesized that infants would have an upper airway that was resistant to collapse. We, therefore, compared the upper airway pressure-flow (V) relationship during sleep between normal infants, prepubertal children, and adults. We evaluated the upper airway response to 1). intermittent, acute P(NEG) (infants, children, and adults), and 2). hypercapnia (children and adults). We found that adults had a more collapsible upper airway during sleep than either infants or children. The children exhibited a vigorous response to both P(NEG) and hypercapnia during sleep (P < 0.01), whereas adults had no significant change. Infants had an airway that was resistant to collapse and showed a very rapid response to P(NEG). We conclude that the upper airway is resistant to collapse during sleep in infants and children. Normal children have preservation of upper airway responses to P(NEG) and hypercapnia during sleep, whereas responses are diminished in adults. Infants appear to have a different pattern of upper airway activation than older children. We speculate that the pharyngeal airway responses present in normal children are a compensatory response for a relatively narrow upper airway.     

Sex and limb-specific ischemic reperfusion and vascular reactivity

With little known regarding sex and limb heterogeneity, we investigated vascular reactivity and ischemic reperfusion (IR) in the upper and lower extremities of 15 healthy men (26 +/- 2 yr) and women (23 +/- 1 yr). Doppler ultrasound was used to evaluate IR and flow-mediated dilation (FMD) after suprasystolic cuff occlusion in both the arm [brachial artery (BA)] and the leg [popliteal artery (PA)]. Cumulative IR [area under the curve (AUC)], normalized for muscle mass, revealed no sex-related differences in either limb (forearm: men 38 +/- 3 and women 44 +/- 4 ml/100 g; lower leg: men 12 +/- 2 and women 14 +/- 2 ml/100 g), while both groups revealed a greater IR per unit of arm muscle mass (AUC) compared with the lower leg (P < 0.05). The BA and PA were smaller in women (BA 0.31 +/- 0.1, PA 0.47 +/- 0.1 cm) than in men (BA 0.41 +/- 0.1, PA 0.6 +/- 0.2 cm). Absolute FMD/shear rate revealed attenuated vascular function in the PA of the women [women 3.3 +/- 0.6, men 5.0 +/- 0.8 (all x10(-6)) cm/s(-1).s] and no sex difference in the BA [women 1.2 +/- 0.2, men 1.6 +/- 0.1 (all x10(-6)) cm/s(-1).s]. In both sexes the PA demonstrated greater vascular reactivity than the BA. Thus vascular reactivity in healthy young people is greater in the legs, regardless of sex, and women have vascular function similar to men in the upper extremities but appear to have poorer vascular function normalized for shear rate in the lower extremities.     

Assessing motivation in children using a progressive ratio task

The association of age and sex on the performance of a progressive ratio task was studied in 847 children, ages 4-14 years. Variations of this task have been used extensively with animals and to a lesser extent with humans to study factors that affect aspects of motivation. The participants in this study were required to press a response lever for nickel reinforcers during a 10 min period. One response was required to earn the first nickel and each subsequent nickel required an additional 10 more responses. Older children had a significantly higher breakpoint than younger children. This appeared to be mostly the result of older children having significantly shorter inter-response times than younger children. In addition, boys had significantly higher breakpoints than girls, especially at older ages. The results of this study illustrate that both age and sex influence the performance of this task and thus suggest that age and sex influence aspects of motivation in children. Further, characterization of performance of this task by humans facilitates comparisons with animal models and, thus, enhances its translational utility.     

Epidemiological and diagnostic aspects of human Cryptosporidiosis in Chile]

Cryptosporidium sp. infections have been reported in different Chilean localities, both in healthy individuals and immunocompromised patients. Among the first, hospitalized and ambulatory children less than 3 years old are the age group more affected reaching frequencies from 3.1 up to 19.3%. In pre-school children, school children and adults the prevalence rates have been 1.1, 0.2 and 0.3% respectively. According to the epidemiological studies carried out, the routine laboratory diagnosis of this parasitosis should be emphasized in the parasitological stool examinations in children under 3 years of age, and selectively in the older ones.     

Factors associated with the intellectual ability of children born to women with high risk pregnancies.

The intellectual abilities of 242 children born to women who had been hypertensive during pregnancy were assessed at the age of 7 1/2 years. Associations between 15 maternal, fetal, perinatal, postnatal and environmental factors, and test scores were investigated. After adjustment for confounding variables children in the upper social classes, born to non-smokers, who were first born, breast fed, and with birth weights above the 10th centile had significantly higher scores in some aspects of ability than the rest. Children whose mothers had developed superimposed pre-eclampsia had higher scores than those whose mothers had not suffered preeclampsia; and children delivered by elective caesarean section had lower scores than those delivered spontaneously. In a small subgroup of women with particularly high risk pregnancies perinatal mortality had been 10 times greater than in the rest of the sample. At 7 1/2 years the intellectual ability of the survivors in this subgroup did not differ from that of the rest. These findings do not support the notion that there is a quantitative continuum of "reproductive casualty" from mortality to morbidity.     

The relationship between age and baseball pitching kinematics in professional baseball pitchers

Joint range of motion and physical capacities have been shown to change with age in both throwing athletes and non-athletes. The age of professional baseball pitchers could span from late teens to mid-40s. However, the effects of age on the pitching kinematics among professional baseball pitchers are still unknown. In this study, 67 healthy professional baseball pitchers were tested using a 3D motion analysis system. Their mean age was 23.7+/-3.3 years (range 18.8-34.4). The 12 pitchers more than one standard deviation older than the mean (i.e., older than 27.0 years) were categorized into the older group, and the 10 pitchers more than one standard deviation younger than the mean (i.e., younger than 20.4 years) were defined as the younger group. In all, 18 kinematic variables (14 position and 4 velocity) were calculated, and Student's t-tests were used to compare the variables between the two groups. Six position variables were found to be significantly different between the two groups. At the instant of lead foot contact, the older group had a shorter stride, a more closed pelvis orientation, and a more closed upper trunk orientation. The older group also produced less shoulder external rotation during the arm cocking phase, more lead knee flexion at ball release, and less forward trunk tilt at ball release. Ball velocity and body segment velocity variables showed no significant differences between the two groups. Thus, differences in specific pitching kinematic variables among professional baseball pitchers of different age groups were not associated with significant differences in ball velocities between groups. The current results suggest that both biological changes and technique adaptations occur during the career of a professional baseball pitcher.     

Genetic and environmental factors in complex diseases: the older Finnish Twin Cohort.

In studies on the Finnish Twin Cohort, we investigate genetic and environmental determinants of common, complex diseases, and their behavioral risk factors in Finland, a genetically unique and culturally homogenous population. We have formed the following databases: 1) Like-sexed twin pairs (13,888 pairs of known zygosity) form the older Twin Cohort. They have participated since 1975 in mail surveys, in clinical examinations for subsamples, and have been followed-up for morbidity using national medical registers; 2) The older Twin Cohort was expanded in 1996 to include opposite-sex pairs born 1938-1957 (c. 8000 pairs); 3) Two, new longitudinal studies of adolescent twins and their families, form a complementary, ongoing study base described in more detail in an accompanying article. Genetic and environmental effects vary over the life-span, and only longitudinal studies in genetically informative data sets permits the evaluation of such effects. Finally, the inclusion of DNA-based genetic information in a phenotypically rich family data base will offer a unique resource for research in genetic epidemiology and behavioral medicine.